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The 117th Congress Signals a Focus on Telehealth with a Series of Telehealth Expansion Bills

By February 24, 2021 February 26th, 2021 No Comments

With the 117th Congress being sworn in last month and a new administration taking office, the first quarter of 2021 saw a number of new and re-introduced telehealth bills. While the pieces of legislation range in scope, nearly all are related to telehealth coverage and the impact of COVID-19 on healthcare utilization. The majority of these bills are bipartisan and suggests there is a growing appetite for federal action on telehealth in both parties.

Some of the more comprehensive bills are reintroduced versions of legislation proposed in the 116th Congress. The Protecting Access to Post-COVID-19 Telehealth Act of 2021 (HR 366) was introduced by a bipartisan group in late January to permanently expand many of the temporary telehealth flexibilities and expansions allowed during the Public Health Emergency (PHE). A version of this bill that was introduced in July 2020 never made it out of committee. HR 366 addresses a number of key flexibilities:

  • Eliminates Medicare’s geographic restrictions starting on Dec. 31, 2021
  • Allows the home as an originating site for all eligible services starting Jan. 1, 2022
  • Grants the Department of Health & Human Services permanent disaster waiver authority to expand telehealth
  • Authorizing Centers for Medicare & Medicaid Services (CMS) to reimburse for telehealth 90 days after the PHE is rescinded.
  • Require the Department of Health & Human Services to conduct a comprehensive study on telehealth utilization, costs, and geographic disparities.
  • Allow FQHCs and RHCs to bill as distant site providers and clarifies that telehealth services includes a rural health clinic or FQHC service that is furnished using telehealth to the extent that payment codes correspond to the service.

On the Medicare front, HR 366 would be a major shift from business as usual prior to the pandemic since beneficiaries would now be permitted to receive telehealth services from their homes regardless of the rural or urban designation once fully implemented.

Another similar bill introduced by Rep. Roger Williams (R-TX), HR 341, would also remove the originating site requirements beginning on the first day of the emergency period while also permitting Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) to be reimbursed as a distant site provider of telehealth services for any service furnished after the emergency declaration. The bill also clarifies that costs associated with the delivery of telehealth services by a FQHC or RHC serving as a distant site shall be considered allowable costs for purposes of the prospective payment system and any applicable payment methodologies. Additional changes introduced in HR 341 include permanently waiving CMS’ face-to-face visit requirement between home dialysis patients and physicians as well as allows the use of telehealth to conduct a face-to-face encounter for the recertification of eligibility for hospice care during any period beginning on or after the first day of the emergency period, and encourages use of telecommunications systems for home health services. A previous version of this bill introduced in the 116th Congress included a sunset of September 2025 for these expansions.

Congressional lawmakers also indicated they might take action on interstate licensing regulations with two bills designed to make it easier for providers to deliver care across state lines during the pandemic. The Equal Access to Care Act (S. 3993) was first introduced in June 2020 and would temporarily allow providers who are licensed and legally authorized to provide care in their primary state to practice telehealth with a patient located in another state. The law would remain in effect until 180 days after the PHE is rescinded by the President. More recently, lawmakers reintroduced the Temporary Reciprocity to Ensure Access to Treatment Act (TREAT) as HR 708, along with a similar Senate bill S 168. Although the text of HR 708 and S 168 has not been made available, text from the previous version of the bill suggests it is nearly identical in scope to the Equal Access to Care Act with the exception that HR 708 would grant HHS authority to unilaterally create similar temporary licensure regulations in the event of future emergencies. Both pieces of legislation would bring clarity to the United States’ patchwork of licensure laws, which are primarily established by state medical or other professional boards.

CCHP is tracking additional federal bills, however many of them do not yet have published text associated with them. They are listed below along with the bill’s official description/title:

  • HR 937: Amends title XI of the Social Security Act to integrate telehealth models in maternity care services, and for other purposes.
  • HR 726: Authorizes the Secretary of Health and Human Services to award grants to eligible entities to conduct diagnostic testing for COVID-19, and related activities.
  • HR 596: Increases the ability of nursing facilities to access telehealth services and obtain technologies to allow virtual visits during the public health emergency.
  • HR 318: Amends title XVIII to provide coverage and payment for certain tests and assistive telehealth consultations during the COVID-19 emergency period, and for other purposes.

Finally, a draft of the next COVID relief bill titled the ‘American Rescue Plan Act of 2021’ was recently released.  The bill draft contains several grant and pilot opportunities that would fund delivery of healthcare via telehealth or expand telehealth infrastructure. These include the following:

  • Emergency Grants for Rural Health Care – Pilot program under the Secretary of Agriculture to help facilities increase telehealth capabilities, including underlying health care information systems (among other items).
  • Funding for Indian Health – $140,000,000 for information technology, telehealth infrastructure and the Indian Health Services electronic health record system.
  • Funding for Community-Based Funding for Local Behavioral Health Needs – Funds can be used to provide mental and behavioral health services to individuals with mental health needs as delivered by behavioral and mental health professionals utilizing telehealth services.
  • Emergency Assistance to Families through Home Visiting Programs – Entities can use funds to serve families with home visits or with virtual visits that may be conducted by the use of electronic information and telecommunications technology, in a service delivery model described in 511(d)(3)(A).
  • Grants to support survivors of sexual assault – Funds to be used to assist rape crisis centers in transitioning to virtual services and meeting the emergency needs of survivors.

Stay tuned to CCHP’s March newsletter for further details. To keep up to date on all the bills CCHP is tracking, regularly check our legislative and regulatory tracking tool.